Mortality in Patients with PAD with Respect to Glycaemic Status – A Review

Iren D. Hjellestad,1 Torbjørn Jonung2,3

1. Department of Medicine, Haukeland University Hospital, Bergen, Norway
2. Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway
3. Department of Clinical Sciences, University of Bergen, Bergen, Norway

Disclosure: No potential conflict of interest.
Acknowledgement: Authors would like to thank Eirik Søfteland, MD, PhD fellow, for his contribution of critical revision of the manuscript.
Received: 20.09.13 Accepted: 11.11.13
Citation: EMJ Diabet. 2013;1:44-50.

Abstract

Peripheral arterial disease (PAD) is a manifestation of atherosclerosis. Atherosclerosis is a chronic inflammatory process and nonenzymatic glycation is a process of major interest in relation to how risk factors promote atherogenesis. A strong association between diabetes mellitus (DM) and PAD has been established, and the association is related to the duration of DM. Previous studies have revealed a higher prevalence of DM in patients with PAD compared to general populations and populations at risk of developing DM. The typical dyslipidaemia found in patients with PAD is similar to that found in patients with insulin resistance, and an association of HbA1c with atherogenic dyslipidaemia is described. HbA1c has been described as a predictor for DM and of micro and macrovascular disease. 5-year all-cause mortality in PAD is 19–37% and 10-year all-cause mortality is 42-54%. The mortality in PAD increases with age, with the severity of the peripheral vascular disease, and with the coexistence of PAD with coronary artery disease and DM. Patients with DM, defined by glucose criteria, and PAD have an increased mortality compared with patients with PAD alone. Recent studies have shown an association of HbA1c levels with vascular complications and death in patients with DM. No studies could be found that aimed to validate HbA1c against glucose criteria as a predictor for mortality in patients with PAD. Further studies on patients with PAD and DM are needed to identify which is the best diagnostic method to predict mortality in PAD with respect to glycaemic status: the glucose parameters or the HbA1c.

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